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Lifestyle Interventions Addressing Blood Pressure in Children: A Systematic Review
Charlotte H Tiplady1, Jonathan P Mynard2,3,4, Moya Vandeleur2,3,5
1Melbourne Medical School, University of Melbourne, Melbourne, Victoria, Australia.
Insights
School-based lifestyle interventions can improve pediatric blood pressure. Multicomponent programs focusing on physical activity and nutrition show the most promise for reducing high blood pressure in children.
Area of Science:
- Pediatric Health
- Cardiovascular Health
- Public Health Interventions
Background:
- Rising prevalence of high blood pressure in children poses long-term health risks.
- Limited evidence exists for pediatric lifestyle interventions to manage hypertension.
- Early intervention is crucial for preventing adult cardiovascular disease.
Purpose of the Study:
- To evaluate the effectiveness of school- or community-based lifestyle interventions for reducing high blood pressure in children (aged 3-18).
- To identify key intervention components that contribute to successful blood pressure reduction.
- To synthesize evidence on pediatric hypertension management strategies.
Main Methods:
- Systematic review of randomized clinical trials and quasi-experimental studies (June 2013-March 2024).
- Inclusion criteria: >6-month duration, ages 3-18, focus on cardiometabolic risk, pre/post blood pressure measurement.
- Exclusion of interventions for specific patient groups; quality assessment using Joanna Briggs Institute tools.
Main Results:
- 27 studies included; 13 showed beneficial effects on blood pressure.
- Interventions commonly targeted physical activity (24 studies), nutrition (15), and education (16).
- Multicomponent interventions (14 studies) demonstrated significant benefits in 9 instances.
Conclusions:
- Lifestyle interventions are effective for improving pediatric blood pressure.
- Multicomponent approaches combining physical activity and nutrition are most promising.
- Further research needed on intervention design, dosage, feasibility, and long-term outcomes.
Importance:
The prevalence of high blood pressure in children is increasing, with health consequences reaching into adulthood. Individual-level interventions may help address the burden of high blood pressure at a population level, but there is less evidence from pediatric settings.
Objective:
To assess the effectiveness of school- or community-based lifestyle interventions to reduce high blood pressure in children (aged 3-18 years) and identify components that support effectiveness.
Evidence Review:
Ovid MEDLINE, Embase, and PubMed were searched for studies from June 2013 to March 2024. Randomized clinical trials and quasi-experimental studies were assessed using the following strict inclusion criteria: longer than 6-month intervention duration, participants aged 3 to 18 years, major aim to modify cardiometabolic risk, and measurement of blood pressure before and after the intervention. Interventions aimed at specific patient groups were excluded. Quality assessment was performed using the Joanna Briggs Institute critical appraisal tools. Blood pressure before and after the intervention was extracted, with the mean difference in blood pressure recorded. Data analysis was performed from June 2023 to July 2024.
Findings:
A total of 27 studies were included, of which 13 reported a beneficial effect on blood pressure; 24 studies targeted physical activity, 15 targeted nutrition, 16 targeted education, and 11 included family involvement. Of 14 multicomponent studies, 9 reported a beneficial effect on blood pressure.
Conclusions And Relevance:
In this systematic review, results indicate that lifestyle interventions can have a beneficial effect on blood pressure in the pediatric population, with multicomponent designs targeting both physical activity and nutrition showing the most promise. Future research should aim to further clarify intervention design and physical activity dosage, feasibility, and scalability, along with the long-term success of interventions that promote healthy blood pressure in children.
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